The Bay Area Reporter - August 15, 1995
Virg Parks, ACT UP Golden Gate Writer's Pool

The original act provided these supplemental funds for five years. If not reallocated by September 30th, the program will cease to exist. In the Bay Area, that translates into massive budget cuts at San Francisco General's HIV Clinic, East Bay AIDS Clinic, Open Hand and Shanti - to name a few.

Edward Zold is a member of both ACT UP Golden Gate and the California HIV Comprehensive Care Working Group, which makes recommendations to the state regarding distribution of Ryan White funds. Zold stresses the importance of full funding for the act, saying, "The Care Act provides vital life-saving programs to individuals who otherwise would have no access to essential services. This safety net has been solely responsible for keeping tens of thousands of individuals alive, healthy, and productive."

Ominous amendments

Many of the homophobic attacks to Ryan White funding so far have been directed at the Special Programs of National Significance (SPiNS). According to Zold, "SPiNS provides funding off-the-top for programs with targeted outreach to underserved populations. In most cases, that has meant women and children. Because some of the programs target gay youth, [North Carolina Senator Jesse] Helms was attacking it."

Although attacks to SPiNS and gay-specific services were deflected and proposals to cap or restrict AIDS care funding defeated, two Helms-sponsored amendments which threaten the welfare of people with HIV passed with no opposition. One is an amendment that allows federal employees to opt out of AIDS training; most readers of this publication should be able to visualize blue rubber gloves and imagine what abuses could result from this amendment.

An amendment requiring states to establish programs for the mandatory spousal notification of a positive HIV result was presented to the Senate as a means of protecting women from infection by HIV-positive spouses. Unfortunately, it might jeopardize the safety of as many women as it protects.

Eileen Hansen of Women's AIDS Network and AIDS Legal Referral Panel elaborates, "With increased emphasis on testing of pregnant or childbearing women, many more women who are unaware of their risk will be tested." Hansen continues, "But even though women are more often infected by their husbands, how many heterosexual men are routinely tested as part of their healthcare? In most cases, such legislation provides little real benefit to women. It is the woman whose husband is physically or emotionally abusive who will pay for this shortsighted amendment."

Compromises or alternatives have been utilized in state and local health departments considering mandatory partner notification - including exceptions if the requirement would unduly threaten the patient's physical or emotional well-being or anonymous and voluntary partner notification. The latter is used here in San Francisco and has been well-received. However, no such compromises or alternatives were proposed to this Helms-sponsored amendment.

Amendments expected in the House of Representatives include one proposed by Congressman Tom Coburn (R-Oklahoma), which would require states to develop programs for the mandatory testing of newborns whose mothers were not tested during pregnancy. In response to this, Congressman Henry Waxman (D-California) offered substitute wording to mandate that states establish counseling and offering of voluntary testing as part of standard prenatal care. However, Coburn refuses to consider anything which doesn't include mandatory testing. Therefore, the substitute wording would also provide discretionary funds to states that establish testing programs, including the mandatory testing of newborns whose mothers were not tested during pregnancy. Additionally, if states cannot prove that voluntary testing of pregnant women can reduce the rate of newborn infection within two years, mandatory testing of newborns could automatically be implemented. Coburn and Waxman are working on the language to be jointly proposed.

Although the chair of the House Rules Committee is rumored to be discouraging any additional amendments, HIV advocates are concerned that negative amendments similar to those proposed by Helms may come out of the House.

Making progress

Although potentially destructive amendments were attached to the CARE Act before it left the Senate - and more are anticipated in the House - efforts to educate legislators have made an impact. Winnie Stachelberg of the Human Rights Campaign Fund emphasizes how a narrow defeat can be seen by the gay community as a success. "Phone calls and letters from constituents have made a difference," she says. "We came very close to defeating the Helms amendment regarding promotion of safer sex in the gay community, closer than ever before against such homophobic attacks."

The vote was 54 to 45 in favor of the "No Promo Homo" amendment. It was then tempered by an amendment proposed by Senator Nancy Kassebaum (R-Kansas), which prohibits funding to programs that directly promote homosexual or heterosexual activity or IV drug use, but protects the delivery of essential medical and support services. The Kassebaum amendment passed overwhelmingly by a vote of 76 to 23.

Stachelberg adds, "Seeing the 1995 Care Act approved with few or hopefully no negative amendments is an achievable goal."

Individuals and organizations voicing opposition to mandatory testing were vital in changing Kassebaum's mind on this issue of prenatal testing for women with HIV. She was prepared to propose an amendment that would require states to implement mandatory HIV testing of all pregnant women. In the eleventh hour, she instead proposed (with Massachusetts Senator Ted Kennedy) an amendment that essentially makes into law the Centers for Disease Control's recently published "Guidelines for the Testing of Pregnant Women and Newborns."

Although women's advocates are not in agreement on every detail of the revised amendment, the CDC guidelines stress education, counseling, and the offering of voluntary testing, making them much preferable to mandatory testing. Hansen says people rallied at once on the HIV testing issue: "Tuesday morning, we received word that Kassebaum was considering proposing mandatory testing during Wednesday's debate. Action Alerts went out over the weekend and people literally responded immediately."

What happens now

Despite numerous attacks, the Ryan White CARE Act of 1995 cleared the Senate with overwhelming approval. Floor debates in the House of Representatives will be scheduled when Congress resumes after the Labor Day Holiday. If/when the act clears both houses of Congress, it then goes to a conference committee where conflicting amendments are threshed out. The conference committee will be composed of members from the House Commerce and the Senate Labor and Human Resources Committees. A reconciled version goes back to both bodies and, when passed, goes to President Clinton. All this in less than 30 days!

Nancy Pelosi, the Congressional Representative of San Francisco, traditionally votes in a manner that represents the opinions of her constituents and has proactively tried to improve services for people with HIV/AIDS. Other liberal-to-moderate legislators, however, may feel that the more sensitive issues of testing for pregnant women/newborns and spousal notification compromise them politically. They need to be reminded that an individual patient's right to privacy is well worth fighting for, and such amendments as those proposed by Helms and Coburn do not necessarily protect women and children from HIV. It is most important to contact members who may be on the conference committee. For Californians, those include: Congress members Carlos Moorhead (202/225-4176), Christopher Cox (202/225-5611), Brian Bilbray (202/225-2040), Henry Waxman (202/225-3976), and Anna Eshoo (202/225-8104). It would also be useful to contact Senators Kassebaum and Kennedy, two influential senators who are receptive to input from the gay and HIV communities. As Stachelberg pointed out, this is a battle that can be won - but it must be fought by all of us.
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